Abnormal Craniocervical Motion in Children with Chiari Malformation: What Do Experts Agree On?

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Dr. Richard Anderson discusses his recently published paper on Defining Craniocervical Instability in pediatric patients with Chiari I malformation. Using the Delphi Process, which Anderson explains, this study aimed to better understand spinal instability in children with Chiari I malformation and to clarify when occipito-cervical stabilization or surgery should be considered. Rather than determining specific surgical techniques, the project focused on building consensus around how instability should be defined, helping create standardized inclusion criteria for future clinical research. The work presented here details the development of pediatric-specific recommendations for identifying and characterizing instability, drawing on clinical findings, radiographic markers, and patterns of progressive deformity. The resulting consensus document has since been published to support more consistent diagnosis, management decisions, and future research in pediatric Chiari I malformation.

Anderson also answered a variety of questions including: why headaches may persist after Chiari I surgery, how to evaluate symptoms in very young children who cannot describe their pain, when it is appropriate to see a neurosurgeon, and why surgery is not helpful without clear imaging evidence of compression, and offers tips on how to choose the most qualified surgeon for your child or self.

This lecture was presented completely virtually on Septembr 4th. (2025)